Healthcare Provider Details

I. General information

NPI: 1902033954
Provider Name (Legal Business Name): RADHIKA DASARAJU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 GREENWAY PROFESSIONAL CT
ORLANDO FL
32824-9482
US

IV. Provider business mailing address

14015 EGRET TOWER DR
ORLANDO FL
32837-6197
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 407-660-1667
Mailing address:
  • Phone: 407-447-7100
  • Fax: 407-447-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125053608
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME152421
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: